NPIMap

Organization Active NPI

Blue Rose Physical Therapy LLC

Doing business as Blue Rose Physical Therapy

  • Physical Therapy Clinic/Center
  • North Little Rock, AR
National Provider Identifier
1902475684
Registry record updated Sep 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
BLUE ROSE PHYSICAL THERAPY LLC
Doing business as
Blue Rose Physical Therapy
Practice address
5013 John F Kennedy Blvd
North Little Rock, AR 72116-6720
Phone
(501) 904-2778
Fax
(866) 724-7887
NPI assigned
Jun 17, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Logan Jerry Dockery, PT, DPT, PHDNPI 1609442250
Title
Physical Therapist/Owner
Phone
(501) 904-2778

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

5013 John F Kennedy Blvd
North Little Rock, AR 72116-6720

Mailing address

PO Box 15538
Little Rock, AR 72231-5538

Other names 1

  • Blue Rose Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211104000501 AR Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1759779119 Receives reassigned benefits from 6 practitioners
Practice locations: North Little Rock, AR

National Provider Directory

National Provider Directory

Locations

5013 John F Kennedy Blvd
North Little Rock, AR 72116
Phone (501) 904-2778

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630800000000",
    "number": "1902475684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15538",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722315538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5013 JOHN F KENNEDY BLVD",
            "city": "NORTH LITTLE ROCK",
            "state": "AR",
            "postal_code": "721166720",
            "telephone_number": "501-904-2778",
            "fax_number": "866-724-7887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE ROSE PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-17",
        "last_updated": "2021-09-05",
        "certification_date": "2021-09-05",
        "status": "A",
        "authorized_official_last_name": "DOCKERY",
        "authorized_official_first_name": "LOGAN",
        "authorized_official_middle_name": "JERRY",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/OWNER",
        "authorized_official_telephone_number": "501-904-2778",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT, PHD"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Rose Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blue Rose Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Little Rock, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.